The state government — and many other large employers — were exempt from the law that went into effect Jan. 1.

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“I was really surprised to learn that state employees can't get six months of birth control like other Marylanders who are covered by the Contraceptive Equity Act,” said Baltimore County Del. Shelly Hettleman about a popular provision of the law that allows women to get more than one month of birth control pills with no copay at one time, rather than get refills every month.

Hettleman introduced a bill to cover state workers by closing the loophole in the law, widely hailed by advocates for protecting and expanding contraceptive provisions of the federal Affordable Care Act.

“I find it really puzzling,” she said. “Especially when there's solid research that shows extended birth control coverage lowers unintended pregnancy rates, which should save the state money.”

The state is exempt because the law only applies to state-regulated plans, and for the most part the state government is self-insured and regulated only federally, according to the Maryland Insurance Administration. The state employs just under 110,000 people out of nearly 2.8 million working in the state.

Also exempt are other self-insured companies, which insure the majority of workers in the state, though it’s unclear if they will offer the extended benefits anyway.

The state will not, said Eric Shirk, spokesperson for the Maryland Department of Budget and Management.

"The State Employee and Retiree Health and Welfare Benefits Program fully complies with all state health insurance mandates and the Affordable Care Act, which includes extensive preventive services," Shirk said.

The loophole speaks to the complicated nature of insurance, said Andrea Miller, president of the National Institute for Reproductive Health, which supported Maryland’s efforts to pass a law. The state was at the forefront in 2016 in passing a contraception law that would boost benefits and remain in place if GOP lawmakers in Washington succeeded in repealing the federal law known as Obamacare, she said.

About a dozen states have since passed laws ensuring access coverage of contraception and more are considering legislation, she said.

Maryland’s law requires insurers to offer up to six months of pills at a time with no copay and also provide most other forms of birth control without cost, including over-the-counter Plan B emergency contraception known as the morning-after pill. Women no longer need to get pre-authorization from an insurance company to get implants and IUDs. And the law requires insurers to cover vasectomies, or sterilization, for men without charging out-of-pocket expenses.